Involvement of the practice nurse in supporting older people with heart failure: GP perspectives

Abstract

Aim

To explore the views of general practitioners (GPs) regarding the involvement of the practice nurse (PN) in supporting older people with heart failure (HF) throughout the disease trajectory and identify specific implications for initiating advance care planning and improving end-of-life care.

Methods

Thirty GPs in a large urban area of New Zealand (NZ) participated in in-depth qualitative interviews. The interviews were recorded and transcribed verbatim. Data were entered into Nvivo software and were analysed thematically.

Results

While the GPs' experiences of working with the PN as contributor to the management of older patients with HF were positive overall, very minimal involvement of the PN in palliative and end-of-life care management was identified. However, significant potential for expansion was identified, particularly in the areas PNs are currently involved in, namely communication, education, and coordinating services, all of which are considered essential to effective palliative and end-of-life care.

Conclusion

The views of GPs are important as they employ PNs in NZ and are central to the ways in which the PN role can be developed in the future to improve services for older people with HF throughout the disease trajectory. Our study indicates that there is significant potential to expand the role of the PN throughout the HF disease trajectory, a development which could address some of the current gaps in palliative and end-of-life care management for these patients. Further research is required to develop and evaluate a model which optimizes the PN role throughout the disease trajectory of people with HF.

Keywords:

• End-of-life care
• General practitioners
• Heart failure
• Older people
• Practice nurses
• Primary health care